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w <br /> Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: 000022285 Site Location: 2808 COUNTRY CLUB BLVD Account ID: AR0021257 <br /> Received by: EE0008844 CRAW Received Date: 2/2812005 Print Date: 2/28/2005 1:20:59PM <br /> Assigned To: EE000$844 CRAW Assigned Date: 212812005 <br /> t <br /> Program/Element Code:2200-HAZARDOUS WASTE GENERATOR PROGRAM <br /> Complainant: ; KALLA(VEEDOR ROOT) !-some Phone <br /> Address Work Phone :800-997-7725 <br /> Nature of complaint. <br /> 2 GALLONS OF FUEL WAS SPILLED BY CUSTOMER <br /> i <br /> Complaint Mode: O Complaint Mode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter <br /> E-Code Enforcement M-Mail l Correspondence O-Other EH Unit P-Phone <br /> ------------------------------------------------- <br /> FACILITY <br /> ------------------------- <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility;FA0012734-SAFEWAY#1769 Owner: OW0009849-DAWES,ROBERT <br /> Site Location 2808 COUNTRY CLUB BLVD RPIDSA SAFEWAY STORE#1769 <br /> STOCKTON,CA 95204 RP Address 5918 STONERIDGE MALL RD <br /> PLEASANTON,CA 94588-3229 <br /> Mailing Address: PO BOX 29096 Billing Address 5918 STONERIDGE MALL RD <br /> PHOENIX,AZ 85038-9096 PLEASANTON,CA 94588-3229 <br /> Home Phone :925-467-3845 Complaint History <br /> Phone :209-461-5555 Work Phone :623-869-6100 Attached But Not <br /> District Location Code 01-STOCKTON Scanned j <br /> APN 12118038 <br /> Date Abated a-v`�x'/� r: 00 <br /> Inspecto [L L/! �ft <br /> lT ------------- <br /> Send <br /> --------Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code I <br /> 01-FIELD ABATED 14-ENFORCEMENT CASE-Transferred to ER FILE <br /> �7 OFFICE ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 03-NAI SENT 16-LETTER SENT TO TENANT ' <br /> 04-NOTICE TO ABATE ISSUED 17-15 DAY LETTER SENT <br /> 05-ENFORCEMENT ACTION INITIATED 18-ENFORCEMENT CASE-Transferred to VECTOR CONTROL FILE <br /> 06-EHD PERMIT FACILITY-see Linked PROGRAM FACILITY FILE 19-ENFORCEMENT CASE-Transferred to WELL PROGRAM FILE <br /> 07-REFERRED TO OTHER AGENCY 20-ENFORCEMENT CASE-Transferred to UIC PROGRAM FILE <br /> 08-UNABLE TO VERIFY 28-FOODBORNE ILLNESS-Unconfirmed <br /> i <br /> 09-FOODBORNE ILLNESS 29-FOODBORNE ILLNESS-Confirmed <br /> 10-SUBSTANDARD PROPERTY-SEE HOUSING ABATEMENT FILE 50.LEAD HAZ EVALUATION REQUIRED(1) <br /> 11-Multiple Complaints-SEE ACTIVE CASE# 51-LEAD HAZ WORK PLAN SUBMITTED(2) <br /> 12-ENFORCEMENT CASE-Transferred to LIQUID WASTE FILE 52-LEAD HAZ ABATEMENT IN PROGRESS(3) <br /> 13-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 53-LEAD HAZ VISUAL INSPECT SATISFACTORY(4) <br /> 5104.rpt g <br />